Contraception: Every Method Compared
The best method is the one that suits your body, your plans and your life. The biggest difference between methods is how much they rely on you remembering.
Quick answer: The most effective reversible methods are the implant and IUDs: fewer than 1 in 100 people get pregnant a year, because there’s nothing to remember. The pill, patch and ring are over 99% effective with perfect use but about 91% with typical use. Condoms also protect against STIs. Emergency contraception works best taken as soon as possible.
Typical vs perfect use. Perfect use is how well a method works when it’s used exactly as directed, every time. Typical use is real life: a late pill, a late injection, a condom put on halfway through. The figures below are pregnancies per 100 people in the first year (Trussell 2011, the figures used by the UK’s FSRH and the NHS). Newer US survey data give slightly lower typical-use rates for some methods, for example about 7 in 100 for the pill and 13 in 100 for male condoms. With no contraception, about 85 in 100 get pregnant within a year.
Long-acting reversible contraception (LARC)
Fit-and-forget methods work best in real life because typical use is the same as perfect use. All are reversible, and fertility returns quickly once they’re removed.
- Most effective · LARCImplant (etonogestrel rod)A matchstick-sized rod placed under the skin of the upper arm with local anaesthetic.
- Pregnancies
- 0.05 in 100 a year, typical and perfect use
- Lasts
- 3 years
- Good for
- Anyone who wants to forget about contraception; suitable for most people who can’t take oestrogen
- Watch for
- Irregular or unpredictable bleeding is the main reason people have it removed; it settles for many.
The most effective reversible method there is. No pills, no maths.
- Most effective · LARCHormonal IUD (levonorgestrel)A small T-shaped device placed in the uterus that releases a progestogen.
- Pregnancies
- About 0.2 in 100 a year
- Lasts
- 3 to 8 years, depending on the device
- Good for
- Heavy or painful periods: many people have much lighter periods or none
- Watch for
- Cramping at insertion and spotting for the first few months.
- Most effective · LARCCopper IUDA hormone-free T-shaped device; copper is toxic to sperm.
- Pregnancies
- 0.8 in 100 typical, 0.6 perfect use
- Lasts
- 5 to 10 years, depending on the device
- Good for
- People who want no hormones; it’s also the most effective emergency contraception
- Watch for
- Periods may be heavier or more painful.
- Very effective · Every 3 monthsContraceptive injection (medroxyprogesterone)A progestogen injection every 12 to 13 weeks.
- Pregnancies
- 6 in 100 typical, 0.2 perfect use
- Lasts
- 12 to 13 weeks per injection
- Good for
- People who don’t want a daily method or a device
- Watch for
- Fertility can take up to a year to return after stopping; small, mostly reversible loss of bone density; some people gain weight.
Pills, patch and ring
- Effective · Daily, weekly or monthlyCombined pill, patch or vaginal ringOestrogen plus a progestogen: a daily pill, a weekly patch or a monthly ring.
- Pregnancies
- 9 in 100 typical, 0.3 perfect use
- Good for
- Lighter, more regular periods; can help acne, period pain and PMS; you can skip periods
- Not for
- Migraine with aura, smoking at 35 or over, a past blood clot, some heart and liver conditions, and some high blood pressure (UKMEC criteria)
- Watch for
- A small increase in blood clot risk; nausea or breast tenderness at first.
- Effective · DailyProgestogen-only pillA daily pill with no oestrogen, so it suits more people.
- Pregnancies
- 9 in 100 typical, 0.3 perfect use
- Timing
- Traditional types must be taken within 3 hours of the usual time; desogestrel within 12 hours and drospirenone within 24 hours
- Good for
- Breastfeeding, migraine with aura, smokers over 35, and people who can’t take oestrogen
- Watch for
- Irregular bleeding.
Barrier, natural and permanent methods
- Male (external) condom: 18 in 100 typical, 2 perfect. The only method that also protects against most STIs. Use water- or silicone-based lubricant with latex.
- Internal (female) condom: 21 in 100 typical, 5 perfect. Also protects against STIs.
- Diaphragm with spermicide: 12 in 100 typical, 6 perfect.
- Withdrawal: 22 in 100 typical, 4 perfect. Better than nothing, but not by much.
- Fertility awareness methods: up to 24 in 100 typical, 0.4 to 5 perfect, depending on the method. They need training and regular cycles. Apps vary a lot in accuracy.
- Vasectomy: 0.15 in 100. A short procedure under local anaesthetic. Use other contraception until a semen test confirms it has worked, usually about 3 months later.
- Tubal sterilisation: 0.5 in 100. Needs an operation and is less effective than an implant or IUD, which are just as long-lasting and reversible.
Condoms are the only method on this list that does double duty against STIs. Pair one with a LARC and you’ve covered both.
Emergency contraception
For sex without contraception, or when a method fails (a split condom, missed pills). The sooner, the better. None of these cause an abortion.
- Copper IUD: the most effective option, with fewer than 1 in 100 getting pregnant. It can be fitted up to 5 days (120 hours) after unprotected sex, or up to 5 days after the earliest likely ovulation, and then keeps working as ongoing contraception.
- Ulipristal acetate pill: works up to 5 days (120 hours) after sex and is more effective than levonorgestrel. Wait 5 days before starting or restarting hormonal contraception, and use condoms until that method is working.
- Levonorgestrel pill: works best within 72 hours (3 days). It may work less well with a weight over 70 kg or a BMI over 26; UK guidance suggests a double dose, ulipristal or a copper IUD instead.
- Emergency pills don’t protect you for the rest of the cycle. Do a pregnancy test 3 weeks after the unprotected sex if your period hasn’t come normally, and consider an STI test.
- In Australia: both emergency pills are available from a pharmacist without a prescription.
Choosing a method
- How well it works for you: if remembering a daily pill is hard, a LARC removes the problem.
- Your health: some conditions rule out oestrogen. Your GP uses medical eligibility criteria (WHO MEC, UKMEC or the Australian adaptation) to check what’s safe.
- Your periods: hormonal IUDs and some pills help heavy periods and period pain; a copper IUD can make them heavier.
- Future plans: most methods wear off quickly, but the injection can delay fertility for months.
- In Australia: implants, some hormonal IUDs and many pills are PBS-subsidised. GPs, sexual health and family planning clinics can fit implants and IUDs.
See your GP if
- You want to start, switch or stop a method
- You’ve missed pills or are late for an injection and aren’t sure what to do
- Bleeding is troublesome, or you bleed after sex or between periods
- You can’t feel your IUD threads, or you have pelvic pain or unusual discharge
Get urgent help for calf pain or swelling, chest pain, sudden breathlessness, coughing up blood, a sudden severe headache or vision changes while using the combined pill, patch or ring: these can be signs of a blood clot or stroke. Severe one-sided lower tummy pain with a missed period, especially with an IUD, needs same-day care to rule out an ectopic pregnancy. Call 000 (Australia) or your local emergency number.
Health days. World Contraception Day is on 26 September: see our health days calendar.
Common questions
What is the most effective form of contraception?
The implant: about 5 in 10,000 users get pregnant a year. Hormonal IUDs, vasectomy and copper IUDs are close behind. All work better in real life than pills or condoms because there’s nothing to remember.
How effective is the pill with typical use?
About 91%: roughly 9 in 100 people using the combined or progestogen-only pill get pregnant in a year, mostly from missed or late pills. With perfect use it’s over 99%.
Does getting an IUD hurt?
It can be uncomfortable or painful for a few minutes, with period-like cramps afterwards. Ask about pain relief options such as local anaesthetic before your appointment.
How long after sex does the morning-after pill work?
Levonorgestrel works best within 72 hours and ulipristal up to 120 hours (5 days), but both work better the sooner you take them. A copper IUD fitted within 5 days is the most effective option.
Does the pill cause weight gain?
A Cochrane review found no evidence that combined pills cause much weight gain. The contraceptive injection is linked with weight gain in some people.
How soon can I get pregnant after stopping contraception?
With most methods, including the pill, implant and IUDs, fertility returns within weeks. After the injection, it can take up to a year.
Do condoms protect against all STIs?
They protect well against most, including HIV, chlamydia and gonorrhoea, but less well against infections spread by skin contact, such as herpes, HPV and syphilis.
Evidence and more information
- Trussell, Contraception 2011: Contraceptive failure in the United States
- WHO 2022: Family planning, a global handbook for providers
- NICE CKS: Contraception, emergency
- Gallo et al, Cochrane 2014: Combination contraceptives, effects on weight
- Guttmacher Institute: Contraceptive effectiveness in the United States
- NHS: Your contraception guide
- healthdirect: Contraception
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